The chief incompetence officer

Speaking at this year's GovTech Conference, the CIO of the Department of Health, Dr Shaheen Khotu, gave a bewildering presentation.

His subject was the National Health Information System of South Africa, and in particular, the provision of an electronic health record. The aim of such a record is to keep all medical data for South Africans where they can be accessed by health services anywhere.

The notion is a good one. Reality, however, is not only far removed from the ideal, but will never get there.

Before launching into his presentation, Dr Khotu insisted at length that the video camera – a standard feature at every GovTech session – be turned off. "It's evidence," he said. "I don't want to end up on ITWeb."

In his introduction he said he'd given the same presentation for 12 years. This came as somewhat of a surprise to everyone, except for one eager young acolyte in the front row.

Mission impossible

He proceeded to assault the audience with a barrage of over 100 presentation slides, each more complex and convoluted than the next. Loaded with tiny text, meshworks of coloured lines, diagrams and tables, he flashed through them so quickly that few were able to catch more than the headlines on most slides. Each was supposed to illustrate either a complex goal, or why complexity made that goal hard to achieve.

On one slide (number 94) the words "Mission Impossible" were emblazoned in big red letters. This was a good summary, at least, of the gist of his presentation.

The only person who appeared to follow everything was the eager young acolyte, who nodded furiously and kept making those annoying noises of affirmation some people make when they listen to a religious sermon.

One of the problems with implementing an individual electronic health record, Khotu explained, is the many standards that one has to comply with. There are, apparently, 22 of them, and this makes the task very hard.

It is also virtually impossible to co-ordinate and integrate systems between different health service providers, such as hospitals, pharmacies and pathology labs, he said.

Another problem is constitutional. Each province keeps doing its own thing, and Dr Khotu's department cannot force them to adopt centralised policies. "While we do have legislative power in the provinces, it is not at the granularity where we can impose standards," he explained.

Who's WHO, anyway?

When the World Health Organisation (WHO) recommended that South Africa might wish to be a little less ambitious, his department demurred. "We insisted we need individual health records, which is how we got on this programme."

That'd be the very same programme he has been telling us for over a decade is unworkable.

When his presentation was over, I withheld judgment. I felt I should at least spend the time to read all 100 slides in detail, and compare them to my notes. I did. I still couldn't make head or tail of it.

Fearing that perhaps I was just not smart enough, I asked some of my colleagues, who were also present to cover GovTech. Those who had seen his presentation before burst out laughing. "You poor man," they said, before describing Dr Khotu in terms that are best left off the record.

None could enlighten me, or give me any reason not to conclude that besides trying to baffle the audience with bulldust, he was saying that a national health record is a national disaster, but that neither he nor his department could help that.

It takes one to know one

As a clincher, he delivered himself of some paranoiac gems.

A previous speaker, Dr Moretlo Molefe, the MD of Telemedicine Africa, had listed a number of impressive case studies, and challenged Dr Khotu by name to "go to Treasury to make a business case" for the national rollout of such projects. "Everyone everywhere is always still piloting," Molefe said. "We must stop piloting and take things that work and up-scale them."

Not true, retorted Dr Khotu. "It's not just pilot projects. I don't answer WHO questionnaires on it, because they just take our ideas. But there are many projects that are working in South Africa."

Earlier, he said that once the individual records have been established, "we can provide personalised health plans based on clinical or even genetic information. The private sector is planning to rip us off by providing us with exactly the same."

This, from the same man who played a Microsoft advertisement for primary healthcare administration as an illustration of the great things he was achieving. The same man who in 2005 was quoted as saying that the Department of Health would "steal" any private intellectual property it felt might be needed to help South African patients. The same man who just spent 40 minutes and 100 slides making excuses for why his department's flagship projects are, at best, a convoluted mess.

I'd call for his dismissal, if I didn't think the zealous acolyte who kept nodding would get the job. But, with Chief Incompetence Officers like this in government, one can only hope that the private sector does indeed plan to rip us off by providing us with exactly the same.

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